中国防痨杂志 ›› 2018, Vol. 40 ›› Issue (5): 447-454.doi: 10.3969/j.issn.1000-6621.2018.05.003
收稿日期:
2018-03-16
出版日期:
2018-05-10
发布日期:
2018-06-12
通信作者:
申阿东
E-mail:shenad16@hotmail.com
基金资助:
Xue QI,Jian-ling TIAN,Lin SUN,A-dong SHEN()
Received:
2018-03-16
Online:
2018-05-10
Published:
2018-06-12
Contact:
A-dong SHEN
E-mail:shenad16@hotmail.com
摘要:
结核分枝杆菌潜伏感染(latent tuberculosis infection,LTBI)严重危害儿童健康。儿童时期的LTBI多由成人传播而来,能够反映所在地结核分枝杆菌的传播流行和疾病控制情况,以及成人结核病流行情况。加强儿童LTBI的管理对于全球结核病的防控具有重要的意义。然而,针对儿童LTBI的筛查指征及方法、预防性治疗方案的选择仍缺乏统一的标准及共识。笔者对WHO指南、不同国家指南及建议、相关临床研究等进行归纳总结,有助于临床医生深入了解儿童LTBI高风险人群及筛查流程;通过推荐相关预防性干预方案,推动儿童LTBI的管理和诊治。
祁雪,田建岭,孙琳,申阿东. 儿童结核分枝杆菌潜伏感染的筛查和预防性治疗[J]. 中国防痨杂志, 2018, 40(5): 447-454. doi: 10.3969/j.issn.1000-6621.2018.05.003
Xue QI,Jian-ling TIAN,Lin SUN,A-dong SHEN. Detection and preventive treatment of latent tuberculosis infection in children[J]. Chinese Journal of Antituberculosis, 2018, 40(5): 447-454. doi: 10.3969/j.issn.1000-6621.2018.05.003
表2
不同机构或治疗方案的儿童TST阳性判读标准
机构或治疗方案 | 硬结平均直径≥5mm | 硬结平均直径≥10mm | 硬结平均直径≥15mm |
---|---|---|---|
WHO[ | 严重营养不良或HIV阳性 | 其余儿童,无论BCG接种与否 | - |
美国儿科学会[ | HIV感染、免疫功能低下或抑制、有临床或影像学异常的疑似结核病患儿、有活动性结核病患者接触史 | <4岁、慢性疾病史、移民或收养于结核病高风险国家 | 其余患儿 |
英国国家卫生与临床优化研究所[ | 无论BCG接种与否 | - | - |
《儿童肺结核的临床诊断标准和治疗方案(试行)》(中国)[ | 原发或继发免疫功能低下、营养不良、重症结核病 | 其他儿童,除外BCG接种免疫反应 | - |
表3
TST和IGRA在活动性结核病密切接触史儿童中筛查LTBI的相关指南[17, 23-24]
推荐方法 | 国家或组织 |
---|---|
单用TST | 法国、巴西、瑞士、斯洛伐克(未接种BCG)、韩国(<5岁)、加拿大(<5岁接触风险低)、日本(<5岁)、爱尔兰(<5岁)、美国儿科学会(<2岁)、欧洲疾病预防控制中心 |
单用IGRA | 挪威 |
两者结合 | |
TST或IGRA二选一 | 丹麦、芬兰、韩国(>5岁,更倾向于TST)、美国疾病预防控制中心(<5岁者更倾向于TST)、美国儿科学会(≥5岁) |
TST和IGRA同时用 | 加拿大(接触风险高)、捷克、克罗地亚、澳大利亚(>2岁考虑IGRA)、葡萄牙(<5岁) |
先行TST,再行IGRA | 德国、意大利、西班牙、沙特阿拉伯、保加利亚、荷兰(根据BCG和TST情况)、葡萄牙(>5岁)、英国(TST阴性)、加拿大(≥5岁低接触风险)、日本(≥5岁)、爱尔兰(≥5岁) |
表4
不同国家和组织推荐的LTBI预防性治疗方案
方案推荐机构 | 治疗方案 | 间隔时间 | 剂量(mg·kg-1·d-1) | 最大剂量(mg/d) |
---|---|---|---|---|
WHO[ | 6 INH或9 INH | 1次/d | 10 | 300 |
3~4 RFP | 1次/d | 15 | 600 | |
3~4 INH+RFP | 1次/d | INH:10;RFP:15 | INH:300;RFP:600 | |
3 INH+Rft | 1次/周,DOTs | INH:15(≥12岁);25(2~11岁) | INH:900;Rft:900 | |
Rft(根据体质量给药)a: 10~14kg=300mg 14.1~25kg=450mg 25.1~32kg=600mg 32.1~49.9kg=750mg ≥50kg=900mg | ||||
美国儿童结核病 | 9 INH | 1次/d | 10~15 | 300 |
协作组[ | 根据体质量给药a: 3~5kg=50mg 6~7.5kg=75mg 7.5~10kg=100mg 10~15kg=150mg 15~20kg=200mg >20kg=300mg | |||
2~3次/周,DOTs | 20~30 | 900 | ||
6 RFP | 1次/d | 10~20 | 600 | |
RFP+PZAb | - | - | - | |
美国胸科协会[ | 9 INH | 1次/d | 10~20 | 300 |
2次/周,DOTs | 20~40 | 900 | ||
4 RFP(仅INH不耐受) | 1次/d | 10~20 | 600 | |
3 INH+Rftc | 1次/周,DOTs | - | - | |
英国国家卫生与临 | 6 INH(吡哆醇联用) | - | - | - |
床优化研究所[ | 3 INH(吡哆醇联用)+RFP | - | - | - |
欧洲疾病预防控制 | HIV:6 INH或9 INH或其他方案 | - | - | - |
中心[ | 非HIV:无特定方案 | - | - | - |
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